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2021 Evaluation and Management Summary: New Patient Visits

The document provides guidance on evaluation and management coding for new and established patient office visits in 2021. It lists the CPT codes for new patient visits based on the level of medical decision making and total time spent. Code 99202 is for a new patient visit requiring straightforward medical decision making and 15-29 minutes. Code 99203 is for a new patient visit requiring low medical decision making and 30-44 minutes. Code 99205 is for a new patient visit requiring high medical decision making and 60-74 minutes. Similarly, it provides CPT codes for established patient visits based on the level of medical decision making and total time spent.

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302 views2 pages

2021 Evaluation and Management Summary: New Patient Visits

The document provides guidance on evaluation and management coding for new and established patient office visits in 2021. It lists the CPT codes for new patient visits based on the level of medical decision making and total time spent. Code 99202 is for a new patient visit requiring straightforward medical decision making and 15-29 minutes. Code 99203 is for a new patient visit requiring low medical decision making and 30-44 minutes. Code 99205 is for a new patient visit requiring high medical decision making and 60-74 minutes. Similarly, it provides CPT codes for established patient visits based on the level of medical decision making and total time spent.

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medical coding
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2021 Evaluation and Management Summary

New Patient Visits


MEDICAL
2021 CPT
CODE DESCRIPTION DECISION TOTAL TIME
CODE
MAKING
99201 Deleted Code Deleted N/A
99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires Straight forward 15–29
a medically appropriate history and/or examination and straightforward medical decision making.
When using time for code selection, 15–29 minutes of total time is spent on the date of the encounter.
99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires Low 30–44
a medically appropriate history and/or examination and low level of medical decision making.
When using time for code selection, 30–44 minutes of total time is spent on the date of the encounter.
99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires Moderate 45–59
a medically appropriate history and/or examination and moderate level of medical decision making.
When using time for code selection, 45–59 minutes of total time is spent on the date of the encounter.
99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires High 60–74
a medically appropriate history and/or examination and high level of medical decision making.
When using time for code selection, 60–74 minutes of total time is spent on the date of the encounter.
(For services 75 minutes or longer, see Prolonged Services 99XXX)

Established Patient Visits


MEDICAL
2021 CPT
CODE DESCRIPTION DECISION TOTAL TIME
CODE
MAKING
99211 Office or other outpatient visit for the evaluation and management of an established patient, that N/A N/A
may not require the presence of a physician or other qualified health care professional. Usually,
the presenting problem(s) are minimal.
99212 Office or other outpatient visit for the evaluation and management of an established patient, Straight forward 10–19
which requires a medically appropriate history and/or examination and straightforward medical
decision making.
When using time for code selection, 10–19 minutes of total time is spent on the date of the encounter.
99213 Office or other outpatient visit for the evaluation and management of an established patient, which Low 20–29
requires a medically appropriate history and/or examination and low level of medical decision making.
When using time for code selection, 20–29 minutes of total time is spent on the date of the encounter.
99214 Office or other outpatient visit for the evaluation and management of an established patient, Moderate 30–39
which requires a medically appropriate history and/or examination and moderate level of
medical decision making.
When using time for code selection, 30–39 minutes of total time is spent on the date of the encounter.
99215 Office or other outpatient visit for the evaluation and management of an established patient, which High 40–54
requires a medically appropriate history and/or examination and high level of medical decision making.
When using time for code selection, 40–54 minutes of total time is spent on the date of the encounter.
(For services 55 minutes or longer, see Prolonged Services 99XXX)
2021 Evaluation and Management Flowchart

15–29 minutes
99202
Straightforward MDM

30–44 minutes
99203
Low MDM

New Patient
45–59 minutes
99204
Moderate MDM

60–74 minutes
99205
High MDM

99211 5 minutes

10-19 minutes
99212
Straightforward MDM

20-29 minutes
99213
Established Patient Low MDM

30-39 minutes
99214
Moderate MDM

40-54 minutes
99215
High MDM

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